Syria

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Despite the extent of the crisis in Syria and people's needs, MSF is significantly constrained in its presence and medical activities in the country, mainly due to insecurity but also due to a lack of agreements and authorisations. These constraints are as present today as they were a year and a half ago. To this date, the Syrian government has not granted us authorisation to work in the country. MSF nevertheless continues to directly operate six health facilities in the north of Syria.

Since 2011, MSF has been supporting a growing number of medical structures in some of the most conflict-affected areas of Syria, and in areas where MSF does not have direct access to patients. A particular emphasis has been placed on supporting facilities situated in areas under siege.

MSF runs programmes of active regular support to 70 medical structures, which vary from small rural health posts to full hospitals in urban areas. The supported structures are located throughout much of the country, including in the governorates of Deraa, Hama, Homs, Idlib and rural Rif Damascus.

MSF teams also work in the countries neighbouring Syria, providing assistance to refugees and host communities.

The humanitarian situation

After five and a half years of intense conflict, the situation in Syria keeps deteriorating, with ever-increasing unmet needs and suffering. It is estimated that 4.8 million people have fled the country, and another 6.5 million people are internally displaced (source: OCHA). This represents nearly 50 per cent of the total population.

The ‘humanitarian system’ is failing in Syria. Assistance, including access to food and medical supplies, remains appallingly insufficient. The pervasive daily reality for many people in Syria is one of fear, deprivation, and a struggle to survive. Through many parts of the country access to medical care is dire due to a crumbling health system. Many hospitals are facing critical supply shortages, and there are ever-diminishing numbers of health workers, as medics have fled or been killed. From the beginning of the conflict medical staff and medical facilities have been targeted.

Aleppo is in an exceptionally critical situation. In east Aleppo city where MSF carries out remote support to medical facilities, an estimated 250,000 people are militarily encircled and a full siege is in operation, starving the population of the basics required for survival, such as food, medical supplies, and fuel to pump water and generate electricity. Furthermore, civilian areas and hospitals are being routinely hit in targeted or indiscriminate bombing and shelling. Attacks by opposition groups occur in west Aleppo which is government controlled but we do not have support programmes there due to a lack of authorisation, hence we do not have any information on the situation other than what is in the media.

Even those people who manage to flee the fractured front lines or besieged areas and reach the border are finding it increasingly difficult or at times impossible to seek refuge abroad. Border restrictions and closures are forcing people to return to the places in Syria they have fled or to camp out in the desert with no facilities or resources, at risk of violence, disease and hunger. This is the case for example in the berm where 75,000 Syrians are stranded between the Syrian and Jordanian borders.

According to hospital staff on the ground, the hospital was destroyed by at least one airstrike which directly hit the building, reducing it to rubble. Other airstrikes in the neighbourhood also hit areas close to the hospital.

The Syrian conflict that began in 2011 has created the biggest displacement crisis since the Second World War, and millions of people are in desperate need of lifesaving humanitarian aid.

Some 4.3 million people have fled the country and an estimated 6.6 million have been internally displaced as government troops, opposition forces and insurgent groups battle for power and control of territory. The complex war has been characterised by extreme violence: civilian areas have been routinely bombed – often in ‘double-tap‘ attacks in which the initial strike is followed by a second on rescue teams or on the healthcare facility receiving the wounded; and there have been attacks resulting in symptoms of exposure to chemical agents. At least 1.5 million people are still trapped in besieged areas without access to humanitarian aid, healthcare or medical evacuation.

The Syrian government continues to deny repeated requests by Médecins Sans Frontières (MSF) to access government-controlled areas. In a country where we should be running some of our largest medical programmes, the opportunities to reach people and to respond in a timely manner to the enormous needs remains extremely limited. This is a forceful reminder of how access to medical care is by and large not respected and is in many cases directly targeted by those involved in the conflict and used for political purposes.

Following the Islamic State (IS) group’s abduction and release of MSF staff in 2014, and the impossibility of obtaining the necessary guarantees from IS leadership that MSF patients and staff will not be taken or harmed, the difficult decision was taken to withdraw from IS-controlled areas. MSF’s activities have consequently been limited to regions controlled by opposition forces, or restricted to cross‐frontline and cross‐border support to medical networks.

In 2015, MSF continued to operate six medical facilities in different locations across northern Syria and saw an increase in the number of people with medical complications caused by delayed medical care, and in infections and deaths due to shortages of antibiotics.

MSF also increased its support programme to around 70 healthcare facilities run by Syrian doctors, with a particular focus on besieged areas. MSF provides technical advice, medical supplies, salaries and fuel, and helps rebuild damaged buildings. MSF also provides ad hoc support to around 80 other medical facilities, such as medical donations for use in emergency situations, for example massive influxes of casualties. No MSF staff are present in these supported facilities.

During 2015, 23 MSF-supported Syrian health staff were killed and 58 wounded. Furthermore, 63 MSF-supported hospitals and clinics were bombed or shelled on 94 separate occasions in 2015; 12 of these facilities were completely destroyed.